Association between postterm pregnancy and adverse growth outcomes in preschool-age children

Abstract

Background: Postterm pregnancy has been associated with higher risk of perinatal mortality and morbidity, but its long-term health effects on offspring are poorly understood.

Objectives: The aim of the study was to investigate the prospective associations between maternal postterm pregnancy and adverse growth outcomes in children.

Methods: The Jiaxing Birth Cohort is part of a large population-based health surveillance system in China and recruited pregnant females resident in the Jiaxing area between 1999 and 2013; newborns were followed up for a median duration of 5.8 y until they went to school. Mother-child pairs with maternal gestational information and offspring's anthropometric data at 4-7 y old were included. Postterm pregnancy was defined as maternal gestational age ≥42 and <47 wk, and its associations with offspring obesity, overweight/obesity, and thinness during childhood were determined by using Poisson regression models.

Results: Of the 101,505 included mother-child pairs, 2369 (2.3%) children were born at postterm. Children born at postterm had significantly lower BMI-for-age z score, weight-for-age z score, and height-for-age z score than those born at term; the mean difference (95% CI) was -0.11 (-0.15, -0.06), -0.17 (-0.21, -0.13), and -0.16 (-0.20, -0.12), respectively. When comparing postterm with term pregnancy, the multivariable-adjusted RRs and 95% CIs among preschool-age children were 0.87 (0.68, 1.11) for obesity, 0.82 (0.72, 0.94) for overweight/obesity, and 1.18 (1.09, 1.28) for thinness, respectively. These risk estimates were robust in sensitivity analyses, but were attenuated in several subgroups stratified by age, sex, mode of delivery, and fetal distress.

Conclusions: Postterm pregnancy was associated with a higher risk of thinness, and a lower risk of overweight/obesity, as well as lower growth parameters in preschool-age children. These findings imply that postterm pregnancy may impede the long-term growth of offspring.

Keywords: birth cohort; children; growth outcomes; overweight/obesity; postterm pregnancy; thinness.

FIGURE 1

Flowchart of the study cohort for analysis.

FIGURE 2

Differences of growth indicators between term- and postterm-born children. The numbers of participants born at term and postterm were 51,352 and 1078 for males, 47,784 and 1291 for females, and 99,136 and 2369 for all children, respectively. ¹BMI-for-age z score, weight-for-age z score, and height-for-age z score were calculated according to WHO reference data. ²Linear regression models were used to examine the differences in growth indicators between postterm- and term-born children with adjustment for calendar year of birth; maternal characteristics including age at delivery, BMI at enrollment, weight gain during pregnancy, gestational hypertension, smoking during pregnancy, alcohol consumption during pregnancy, educational level, and employment status; paternal educational level and employment status; and offspring sex, birth weight, mode of delivery, and presence of fetal distress.

FIGURE 3

Subgroup analyses of associations between postterm pregnancy and risk of adverse growth outcomes. RRs and 95% CIs were estimated by Poisson regression model 3 with adjustment for calendar year of birth; maternal characteristics including age at delivery, BMI at enrollment, weight gain during pregnancy, gestational hypertension, smoking during pregnancy, alcohol consumption during pregnancy, educational level, and employment status; paternal educational level and employment status; and offspring sex, birth weight, mode of delivery, and presence of fetal distress.